Suture anchor with insert-molded rigid member

ABSTRACT

A threaded suture anchor with an eyelet shield transversely molded at a distal end of the anchor body, over which one or more strands of suture is looped. The anchor body is threaded and has a tapered distal portion. The proximal end portion of the suture anchor body has a polygonally shaped opening to accept a polygonal drive head, preferably hexagonal or square. The peripheral surface defining polygonally shaped opening is rounded and smooth to prevent abrading sutures placed in contact therewith. In another embodiment, a push-in anchor is provided with an eyelet shield at the proximal end of the anchor.

This application is a continuation of U.S. application Ser. No. 11/518,872, filed on Sep. 12, 2006, now U.S. Pat. No. 8,821,541, which is a continuation-in-part of U.S. application Ser. No. 11/097,172, filed on Apr. 4, 2005, now U.S. Pat. No. 8,343,186. This application is also a continuation-in-part of U.S. application Ser. No. 10/083,568, filed on Feb. 27, 2002, now U.S. Pat. No. 7,226,469, which claims priority to U.S. Provisional Application No. 60/271,414, filed on Feb. 27, 2001, and which is a continuation-in-part of U.S. application Ser. No. 09/495,816, filed on Feb. 2, 2000, now U.S. Pat. No. 6,517,564, which claims priority to U.S. Provisional Application No. 60/118,228, filed on Feb. 2, 1999 and U.S. Provisional Application No. 60/125,781, filed on Mar. 23, 1999. This application is also a continuation-in-part of U.S. application Ser. No. 11/224,060, filed on Sep. 13, 2005. This application also claims priority to U.S. Provisional Application No. 60/715,614, filed on Sept. 12, 2005. The disclosures of all of the above-cited applications are incorporated by reference in their entirety.

FIELD OF THE INVENTION

The present invention relates to an apparatus for anchoring surgical suture to bone, and more particularly, to an apparatus using a suture anchor having a transverse anchor pin or an insert-molded eyelet shield.

BACKGROUND OF THE INVENTION

When soft tissue tears away from bone, reattachment becomes necessary. Various devices, including sutures alone, screws, staples, wedges, and plugs have been used in the prior art to secure soft tissue to bone.

Recently, various types of threaded suture anchors have been developed for this purpose. Some threaded suture anchors are designed to be inserted into a pre-drilled hole. Other suture anchors are self-tapping.

U.S. Pat. No. 4,632,100 discloses a cylindrical threaded suture anchor. The suture anchor of the '100 patent includes a drill bit at a leading end for boring a hole in a bone, followed by a flight of threads spaced from the drill bit for securing the anchor into the hole created by the drill bit.

U.S. Pat. No. 5,370,662 discloses a suture anchor having threads which extend to the tip of the anchor. U.S. Pat. No. 5,156,616 discloses a similar suture anchor having an axial opening for holding a knotted piece of suture.

All of the above-noted suture anchors include a structure for attaching the suture to the anchor. U.S. Pat. No. 4,632,100, for example, discloses a press-fitted disc and knot structure which secures the suture to the anchor. In other suture anchors, such as those disclosed in U.S. Pat. No. 5,370,662, the suture is passed through an eyelet located on the proximal end of the anchor. In the case of a bioabsorbable suture anchor, the suture may be insert molded into the anchor, as disclosed in U.S. Pat. No. 5,964,783.

Problems can arise if the structure for attaching the suture fails, allowing the suture to become detached from the anchor. Also, the suture often is exposed to abrasion or cutting by sharp or rough areas along the walls of the bone canal into which the anchor is inserted.

Moreover, the eyelet or, in the case of U.S. Pat. No. 4,632,100, the axial opening for receiving the disc to which the suture is knotted, is formed as part of the drive head of the known suture anchors. Combining these two functions in one structure often tends to weaken the drive head.

In addition, various other modifications to the drive head often are employed in connection with suture attachment. For example, recessed grooves may be formed on opposite sides of the drive head to receive and protect the suture from abrasive areas of the suture anchor tunnel or to facilitate mating between the anchor to the driver. In such cases, the drive head often must be made of a larger diameter to recover the mechanical strength lost from the removal of material relating to the suture-attachment or suture-protection modifications.

Further, the prior art suture anchors having eyelets extending from the proximal ends require countersinking of the eyelet below the bone surface to avoid having the patient's tissue abrade against the exposed eyelet. As a result, suture attached to the eyelet is vulnerable to abrasion by the bony rim of the countersunk hole into which the suture anchor is installed. In addition, in biodegradable suture anchors, the suture eyelet can degrade rapidly, causing the suture to become detached from the anchor prematurely.

Accordingly, there is a need for a threaded suture anchor to which suture is secured effectively so as to prevent detachment of the suture. It is further desirable for such suture anchors to have eyelets that will not abrade tissue and which do not require countersinking.

Further, there is a need for a suture eyelet shield within a biodegradable suture anchor with a bearing surface that will resist suture cut-through of the bioabsorbable material.

SUMMARY OF THE INVENTION

The suture anchor of the present invention overcomes the disadvantages of the prior art discussed above by providing, in one embodiment, a fully threaded suture anchor with an eyelet shield that is molded into the distal part of the biodegradable suture anchor. The eyelet shield of the present invention provides the strength necessary to secure the suture and also prevents suture cut-through.

The eyelet formed at the distal end is formed of a piece of suture or other material transversely insert-molded into the anchor so as to provide an eyelet shield. The shield provides a bearing surface that will resist suture cut-through.

In accordance with another embodiment of the invention, a ribbed suture anchor is provided with an eyelet shield at the proximal end. The eyelet shield is formed of a loop of suture material which is inserted molded within the suture anchor during the manufacturing process.

Other features and advantages of the present invention will become apparent from the following description of the invention, which refers to the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a side elevational view of the suture anchor according to an embodiment of the invention.

FIG. 2 is a longitudinal sectional view of the suture anchor shown in FIG. 1 through the plane D-D indicated therein.

FIG. 3 is a proximal end view of the suture anchor of FIG. 1.

FIG. 4A is a cross sectional view of the suture anchor of FIG. 1 showing a suture looped over the transverse anchor pin.

FIG. 4B is a cross sectional view of the suture anchor of FIG. 1 showing a portion of a polygonal driver inserted into a polygonally shaped bore of the suture anchor.

FIG. 4C is a cross sectional view of the suture anchor of FIG. 1 showing the polygonal driver inserted into a polygonally shaped bore of the suture anchor.

FIG. 5 is a perspective representation of the suture anchor according to another embodiment of the invention.

FIG. 6 is an end view of the suture anchor shown in FIG. 5.

FIG. 7A is an elevational cross-section of the suture anchor of FIG. 6 through the plane B-B indicated therein.

FIG. 7B is an elevational cross-section of the suture anchor of FIG. 6 through the plane B-B indicated therein showing a portion of a driver inserted into a bore of a suture anchor.

FIG. 8 is a cross-section in plan view of the suture anchor of FIG. 6 through the plane C-C indicated therein.

FIG. 9 is a plan view of the push-in suture anchor according to another embodiment of the invention.

FIG. 10 is a plan view of the push-in suture anchor of FIG. 9 showing a suture insert-molded within the suture anchor.

FIG. 11 is a proximal end view of the suture anchor of FIG. 9.

FIG. 12 is a longitudinal sectional view of the suture anchor shown in FIG. 9 through the plane A-A indicated therein.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

In the following detailed description, reference is made to various specific embodiments in which the invention may be practiced. These embodiments are described with sufficient detail to enable those skilled in the art to practice the invention, and it is to be understood that other embodiments may be employed, and that structural and logical changes may be made without departing from the spirit or scope of the present invention.

FIG. 1 illustrates a suture anchor according to a first preferred embodiment of the present invention, indicated generally by reference numeral 110. In the preferred embodiment, body 108 of anchor 110 generally tapers to a narrow point 114 at the distal end thereof. In particular, the major diameter of the anchor body is generally constant along about two-thirds of the length of the body, whereupon the diameter of the anchor then tapers to a relatively sharp point, e.g., approximately 16°. The relatively sharp distal tip of anchor 110 enables the anchor to be installed without having to first drill a hole in the bone where the anchor 110 is to be installed.

Although such tapering is preferred, suture anchor 110 may be formed to have a less tapered shape, or even cylindrical shape, to accommodate different preferences of the surgeon and/or the application of the suture anchor. For example, the tapered distal end of the anchor may be formed to be more blunt, in which case it is necessary to provide a pre-formed hole in the bone prior to insertion of the suture anchor.

A continuous thread 116 wraps around the body 108 in a clockwise direction, as shown. Anchor 110 has about five flights of thread, with the angle of the threads and other configurations of the anchor being similar to the suture anchor of U.S. Pat. No. 6,511,499, the disclosure of which is hereby incorporated by reference in its entirety.

As can be seen more clearly with reference to FIG. 3, the proximal end portion of the anchor has a polygonally shaped bore 134, preferably hexagonal or square, having an opening 112 at the proximal end 92 of anchor body 108 and extending into the anchor body approximately one-third of the length thereof. Prior art anchors have sharp edges around the drive opening, which is problematic in that sutures passing through the central opening at the proximal end 92 of the anchor can be abraded by the sharp edges, thereby compromising the strength of the sutures. In the suture anchor of the present invention, the peripheral edges defining polygonally shaped opening 112 is smooth and rounded outwardly with no sharp edges. Preferably, the opening 112 forms a slight lip curving around the diameter of the bore 134. Thus, sutures threaded through the anchor 110, as will be discussed below, will not become frayed upon being pressed or rubbed against the anchor at the proximal opening 112.

As shown in FIG. 2, a cylindrical bore 136 having a diameter corresponding to that of the polygonally shaped bore 134 extends from the distal end of the polygonally shaped bore 134 to a position roughly halfway along the length of anchor body 108. The transition between polygonally shaped bore 134 and cylindrical bore 136 forms an annular shoulder 140, against which the distal end of a polygonal driver 202, preferably hexagonal or square, abuts when inserted into the polygonally shaped bore 134 to drive the anchor into bone.

Two longitudinal, diametrically opposite apertures 118 are formed in anchor body 108, the apertures 118 supporting a metal transverse anchor pin 120 which extends across cylindrical bore 136.

As illustrated in FIGS. 1, 2 and 4 a, apertures 118 extend through and interrupt the threads 116 around anchor body 108 at approximately one-third of the length of the anchor body from the proximal end 92 thereof. One or more sutures 200 are secured to the anchor by looping the suture(s) around metal anchor pin 120 as shown in FIG. 4a . Although the metal anchor pin 120 is illustrated in FIGS. 2 and 4 a as oriented transversal to longitudinal axis 150 of the anchor body 108, the metal anchor pin 120 may form any angle with the longitudinal axis 150 and, thus, the invention is not limited to metal anchor pin 120 forming an angle of about ninety degrees with the longitudinal axis 150 of the anchor body 108.

Preferably, suture anchor 110 is formed of a hard biocompatible metal, such as a titanium alloy, but can be made of biocompatible materials other than metal. The suture secured to the anchor may be FiberWire suture, sold by Arthrex, Inc. of Naples, Fla.

The suture anchor according to the present invention need not be formed as a threaded device, but can also be formed as a tap-in type anchor. Also, the measurements, angles and ratios between the dimensions of the suture anchor may be varied from those described above so as to be suitable for the conditions and applications in which the suture anchor is to be used.

In manufacturing the suture anchor 110 in accordance with the present invention, the anchor body 108 is cast in a die, with the bores, passageways and apertures described above either being formed during the casting process or formed afterwards. If necessary, the distal tip 114 of the anchor 110 is trimmed to the desired length and the surfaces of the anchor are polished to the desired finish.

As mentioned above, the suture anchor 110 of the present invention may be installed in the bone without the need to pre-drill a hole in the bone. The suture anchor 110 is installed using a driver 202 having a shaft having a polygonal cross-section for at least a length equal to the length of the polygonal bore 134 from proximal opening 112 to the shoulder 140 inside the anchor 110. The driver 202 has a cannula 204 extending through the entire length thereof, with openings 216 and 214 at the proximal end and the distal end, respectively, thereof. Of course, the outer diameter of the polygonal shaft is sized to fit inside the polygonal bore in the anchor so as to be enabled to drive the same.

As shown in FIGS. 4b and 4c , with the desired number of suture strands 200 threaded around the anchor pin 120 in the suture anchor 110, the ends 206 and 208 of the suture strands 200 are threaded through the cannula 204 in the polygonal driver 202 from the distal end thereof and extend from the proximal opening 216 thereof. The distal end of the polygonal driver 202 is inserted into the proximal end 92 of the anchor 110. With the distal end of the driver 202 abutting the shoulder 140 and the anchor 110 positioned at the location at which it is to be installed, the polygonal driver 202 is rotated to drive the anchor 110 into the bone until the proximal surface of the anchor 110 is flush with the surface of the bone.

Since it is not necessary for the proximal end 92 of the anchor to be countersunk below the bone surface to prevent tissue abrasion by an exposed suture loop, as is required with prior art devices, the suture anchor of the present invention does not need to be inserted as far as the prior art anchors, while also avoiding abrasion of the sutures by the rim of the bone.

The suture anchor of the present invention provides greater pull-out strength of the suture loop than prior suture anchors. In addition, the suture loop of the present invention, being disposed inside the suture anchor, is protected from abrasion and degradation.

Referring to FIG. 5, a suture anchor 1 is shown in perspective in accordance with another embodiment of the invention. In this embodiment, the suture anchor 1 has a fully-threaded body 3. The suture anchor 1 may be comprised of any material. Preferably, suture anchor 1 is formed of a bioabsorbable material. Rather than having an anchor pin as discussed in the embodiment above, the suture anchor 1 has an eyelet shield 9 molded transversely into a distal part 11 of the threaded body 3 of the suture anchor 1. The eyelet shield 9 includes a first end portion 400 that is part of an exterior surface of the suture anchor 1 and a second end portion 401 that is part of an opposite exterior surface of the suture anchor 1. Eyelet shield 9 is shown as a bar, however, any appropriate type of material may be used, including bioabsorbable material or a length of suture, for example. The eyelet shield 9 can include of a length 90 of suture molded transversely into distal part 11 of the threaded body 3. Although the shield 9 is illustrated as being transverse to the longitudinal axis of suture anchor 1, the shield 9 may also be formed at any angle with respect to the longitudinal axis and, thus, the invention is not limited to shield 9 formed an angle of about ninety degrees with the longitudinal axis of the suture anchor 1.

As illustrated in FIGS. 6-8, two strands of tie-down sutures 5, 7 are threaded around the eyelet shield 9 of the distal end 11 of the suture anchor 1 and threaded into a suture passage 94. In one example, there is a suture passage 94 on opposing sides of the shield 9. The shield 9 provides a bearing surface around which sutures 5, 7 are threaded and disposed.

The sutures 5, 7 are threaded through a bore 15 and disposed about a shield 9 and have ends 306 and 308 that extend out of the proximal end 92 of the anchor 1. The bore 15 extends from the proximal end of the suture anchor 1 to a location roughly halfway along the anchor body 1. As discussed above, the bore 15 has an opening at the proximal end of the suture anchor and is shaped to accommodate a driver head for driving the suture anchor.

The eyelet shield 9 resists suture cut-. Further, the shield 9 provides the strength necessary to secure the sutures 5, 7. In addition, because the eyelet shield is molded transversely into the distal end of the suture anchor, this provides greater security to prevent pull-out of the suture from within the suture anchor or from an anchor pin, which could loosen. The eyelet shield also prevents the suture from fraying.

Although a fully-threaded suture anchor 1 with threaded body 3 is shown, the anchor does not necessarily have to be fully threaded. As discussed above, the suture anchor also need not be a threaded device, but can also be formed as a tap-in type anchor. In addition, sutures 5, 7 can be insert-molded into the anchor to prevent saw-through.

The suture anchor 1 is installed using a driver 300. The driver 300 has a cannula 302 with openings at the proximal and distal ends thereof. As shown in FIGS. 7A and 7B, with the desired number of sutures 5 and 7 threaded around the shield 9 in the suture anchor 1, ends 306 and 308 of the sutures 5 and 7 are threaded through the cannula 302 in the driver 300 from a distal end 310 thereof and extend from the proximal opening 312 thereof. The distal end of the driver 300 is inserted into the proximal end 92 of the anchor 1, and the driver 300 is rotated to drive the anchor 1 into the bone until the proximal surface of the anchor 1 is flush with the surface of the bone

In another embodiment, as illustrated in FIGS. 9-12, a push-in suture anchor 20 is shown having suture 22 that is insert-molded longitudinally into the suture anchor body 24 during the manufacturing process.

The suture anchor body 24 preferably is formed of a bioabsorbable material, poly(1-lactide-co-d, 1-lactide) 70:30 (PLDLA) being most preferred. Suture 22 can be any known type of suture selected according to the size of the anchor and the anticipated application. The suture 22 preferably is No. 2 polyester braided suture.

At least one length of the insert-molded suture 22 extends from the proximal end 92 of the suture anchor body 24. Preferably, the suture 22 extends from the suture anchor body 24 in the form of a loop. The suture 22 is insert-molded into the suture anchor body 24 and also into the loop or eyelet 26. Various devices provide a suture anchor with a loop formed of a suture material, as disclosed in U.S. Publication No. 2002/0087190 and U.S. application Ser. No. 11/224,060, the entire disclosures of which are incorporated by reference herein. However, the suture loops disclosed in these applications are not encapsulated—this results in friction between the suture loop and a suture threaded through the loop. In the present invention, the suture 22, being insert-molded within the loop 26, eliminates suture against suture friction and provides better support and strength for a suture threaded through the loop.

The distal end 28 of the suture anchor body 24 tapers to a blunt tip. Suture anchor 20 is provided with slotted ribs 30 formed circumferentially at least partially around and partially along the length of body 24. Ribs 30 have a truncated, conical anchor at an angle of preferably 15° with respect to the longitudinal axis of anchor 20, and reaching a major diameter of 3.0 mm

Although PLDLA is the most preferred material for the suture anchor of the present invention, other bioabsorbable materials known in the art can be utilized. As used herein, bioabsorbable is considered to be interchangeable with biodegradable, resorbable, and absorbable to mean that the device can be at least partially absorbed by the body over time. Preferably, the anchor material is selected so as to absorb or degrade substantially completely within 12-16 months of implantation.

Although the present invention has been described in relation to particular embodiments thereof, many other variations and modifications and other uses will become apparent to those skilled in the art. Therefore, the present invention is to be limited not by the specific disclosure herein, but only by the appended claims. 

What is claimed is:
 1. A suture anchor assembly comprising: an anchor body including a longitudinal axis, an exterior surface, a proximal end, and a distal end, the anchor body including a first opening at the proximal end of the anchor body, the anchor body including an internal passage extending along the longitudinal axis from the first opening through at least a portion of a length of the anchor body, the anchor body including an external helical thread on the exterior surface, the external helical thread extending along the anchor body, wherein the external helical thread extends from the proximal end of the anchor body to a location distal of a rigid support, the external thread extends continuously over 360 degrees around the longitudinal axis for at least a portion of the length of the anchor body, the anchor body including a second opening distal of the first opening, the anchor body including a third opening through the exterior surface of the anchor body and distal of the rigid support of the anchor body, wherein the third opening is distal of the second opening, wherein the rigid support has a leading distal surface, the rigid support extends across the longitudinal axis of the anchor body, the rigid support is integral with and attached to the anchor body to define a unitary single-piece component, the rigid support and the anchor body are made of the same material, the rigid support is disposed in a distal half of the anchor body, and the distal half of the anchor body includes the distal end of the anchor body, a wall is defined by the external helical thread on the exterior surface of the anchor body and a surface of the internal passage, and the rigid support is attached to the surface of the internal passage at two locations at an axially fixed longitudinal position; and a suture strand extending out of the first opening of the anchor body, the suture strand having a first tail with a first end and a second tail with a second end, wherein the first tail and the second tail are unattached to each other prior to tissue fixation, wherein a portion of the suture strand is disposed in the internal passage between the rigid support and the first opening, the suture strand is supported by the leading distal surface of the rigid support, and the suture strand is disposed in the first opening, the second opening and the third opening of the anchor body.
 2. The suture anchor assembly as recited in claim 1 wherein the second opening extends between the wall and the rigid support.
 3. The suture anchor assembly as recited in claim 1 wherein the second opening is through the exterior surface of the anchor body.
 4. The suture anchor assembly as recited in claim 1 wherein the portion of the suture strand disposed in the internal passage is surrounded by the external helical thread of the anchor body.
 5. The suture anchor assembly as recited in claim 1 wherein a portion of the anchor body entirely surrounds the first opening at the proximal end.
 6. The suture anchor assembly as recited in claim 1 wherein the external helical thread begins at the proximal end of the anchor body and ends in the distal half of the anchor body.
 7. The suture anchor assembly as recited in claim 1 wherein at least a portion of the internal passage is defined by a first planar passage face and a second planar passage face that are both generally parallel to the longitudinal axis of the anchor body.
 8. The suture anchor assembly as recited in claim 1 wherein the second opening and the third opening interrupt the external helical thread.
 9. The suture anchor assembly as recited in claim 1 wherein the internal passage is a central passage.
 10. The suture anchor assembly as recited in claim 1 wherein a portion of the first opening is a polygon.
 11. The suture anchor assembly as recited in claim 10 wherein the portion of the first opening is a hexagon.
 12. The suture anchor assembly as recited in claim 1 wherein each of the first tail and the second tail is slidable in two opposing directions within the internal passage.
 13. The suture anchor assembly as recited in claim 1 wherein the internal passage has a first internal surface and a second internal surface spaced opposite to the first internal surface, a first space is defined between the rigid support and the first internal surface of the internal passage, a second space is defined between the rigid support and the second internal surface of the internal passage, the first tail is located in the first space, and the second tail is located in the second space, wherein the suture strand follows a path beginning with the first end of the first tail of the suture strand outside the anchor body, into the first space of the internal passage, around the rigid support, back through the second space of the internal passage, and ending at the second end of the second tail of the suture strand outside of the anchor body.
 14. The suture anchor assembly as recited in claim 1 including a driver having a first planar driver face and a second planar driver face, the first planar driver face of the driver engageable with the first planar passage face of the internal passage and the second planar driver face of the driver engageable with the second planar passage face of the internal passage when the driver is received in the internal passage of the anchor body.
 15. The suture anchor assembly as recited in claim 14 wherein the driver has a cannula, the cannula has a distal opening and a proximal opening, and the first end and the second end of the suture strand extend out of the first opening of the cannula.
 16. The suture anchor assembly as recited in claim 14 wherein the driver includes a shaft having a shaft length, the shaft is received in the internal passage of the anchor body, the suture strand has a suture length, and the suture length of the suture strand is greater than the shaft length of the shaft.
 17. The suture anchor assembly as recited in claim 1 wherein the wall extends from the proximal end of the anchor body to the rigid support.
 18. The suture anchor assembly as recited in claim 1 wherein the wall includes a first wall portion and a second wall portion opposite the first wall portion, wherein the first wall portion and the second wall portion extend from the proximal end of the anchor body to the rigid support.
 19. The suture anchor assembly as recited in claim 1 wherein the longitudinal axis of the anchor body is a central longitudinal axis, the rigid support has an axis substantially perpendicular to the central longitudinal axis of the anchor body, and the central longitudinal axis of the anchor body and the longitudinal axis of the rigid support intersect.
 20. The suture anchor assembly as recited in claim 1 wherein a portion of the rigid support is entirely surrounded by the helical thread.
 21. The suture anchor assembly as recited in claim 20 including a window extending through the wall and having a length that extends along the longitudinal axis, wherein the anchor body includes a fourth opening located at a proximal end of the window, and the fourth opening is adjacent the rigid support.
 22. The suture anchor assembly as recited in claim 21 wherein the fourth opening is entirely surrounded by the external helical thread.
 23. The suture anchor assembly as recited in claim 21 wherein the window has a proximal half, and at least a portion of the rigid support is located in the proximal half of the window.
 24. A suture anchor assembly comprising: an anchor body including a longitudinal axis, a length extending along the longitudinal axis, a proximal end, a distal end, the anchor body including an internal central passage extending from a first opening at the proximal end of the anchor body, the internal central passage extending along the longitudinal axis, and the internal central passage extending through at least a portion of the length of the anchor body, the anchor body including an external helical thread extending along the anchor body on a wall of the anchor body, wherein the external helical thread extends from the proximal end of the anchor body to a location distal of the rigid support, the external thread extends continuously over 360 degrees around the longitudinal axis for at least a portion of the length of the anchor body, the anchor body including a second opening and a third opening, the second opening disposed distal of the first opening, and the third opening disposed distal of the second opening and distal of a rigid support, wherein the rigid support is integral with and attached to the anchor body to define a unitary single-piece component, the rigid support and the anchor body are made of the same material, the rigid support is disposed in a distal half of the anchor body, the distal half of the anchor body including the distal end of the anchor body, the second opening is proximate to the rigid support, the rigid support includes a first end portion and an opposing second end portion, and both the first end portion and the opposing second end portion are integral with and attached to the wall; and a suture strand disposed in the internal central passage, the suture strand having a first tail with a first end and a second tail with a second end, wherein the first tail and the second tail are unattached to each other prior to tissue fixation, wherein the suture strand is supported by the rigid support, the suture strand extends out the proximal end of the anchor body, and the suture strand is disposed in the first opening, the second opening and the third opening of the anchor body.
 25. The suture anchor assembly as recited in claim 24 wherein the second opening is located between the rigid support and the external helical thread on the wall.
 26. The suture anchor assembly as recited in claim 24 wherein a portion of the suture strand disposed in the internal central passage is surrounded by at least a portion of the external helical thread of the anchor body.
 27. The suture anchor assembly as recited in claim 24 wherein a portion of the anchor body entirely surrounds the first opening at the proximal end.
 28. The suture anchor assembly as recited in claim 24 wherein the external helical thread begins at the proximal end of the anchor body and ends in the distal half of the anchor body.
 29. The suture anchor assembly as recited in claim 24 wherein the internal central passage has a first internal surface and a second internal surface spaced opposite to the first internal surface, and the rigid support is secured to and disposed between the first internal surface and the second internal surface at two locations at an axially fixed longitudinal position.
 30. The suture anchor assembly as recited in claim 24 wherein the external helical thread defines a perimeter at least around the proximal end of anchor body.
 31. The suture anchor assembly as recited in claim 24 wherein the internal central passage has a first internal surface and a second internal surface spaced opposite to the first internal surface, a first space is defined between one side of the rigid support and the first internal surface of the internal central passage, a second space is defined between an opposing side of the rigid support and the second internal surface of the internal central passage, the first tail is located in the first space, and the second tail is located in the second space, wherein the suture strand follows a path beginning with the first end of the first tail of the suture strand outside the anchor body, into the first space of the internal central passage, around the rigid support, back through the second space of the internal central passage, and ending at the second end of the second tail of the suture strand outside of the anchor body.
 32. The suture anchor assembly as recited in claim 31 wherein the first tail and the second tail are unattached to each other, and each of the first tail and the second tail is moveable in two opposing directions within the internal central passage.
 33. The suture anchor assembly as recited in claim 24 including a driver having a shaft with a shaft length, the shaft is received in the internal central passage of the anchor body, the suture strand has a suture length, and the suture length of the suture strand is greater than the shaft length of the shaft.
 34. The suture anchor assembly as recited in claim 33 including a driver having a cannula, the cannula having a distal opening and a proximal opening, the first end and the second end extend out of the proximal opening of the cannula.
 35. The suture anchor assembly as recited in claim 24 wherein the wall extends from the proximal end of the anchor body to the rigid support.
 36. The suture anchor assembly as recited in claim 24 wherein the wall includes a first wall portion and a second wall portion opposite the first wall portion, wherein the first wall portion and the second wall portion extend from the proximal end of the anchor body to the rigid support.
 37. The suture anchor assembly as recited in claim 24 wherein the longitudinal axis of the anchor body is a central longitudinal axis, the rigid support has an axis substantially perpendicular to the central longitudinal axis of the anchor body, and the central longitudinal axis of the anchor body and the longitudinal axis of the rigid support intersect.
 38. The suture anchor assembly as recited in claim 24 wherein a portion of the rigid support is entirely surrounded by the helical thread.
 39. The suture anchor assembly as recited in claim 24 including a window extending through the wall and having a length that extends along the longitudinal axis, wherein the anchor body includes a fourth opening located at a proximal end of the window, and the fourth opening is adjacent the rigid support.
 40. The suture anchor assembly as recited in claim 39 wherein the fourth opening is entirely surrounded by the external helical thread.
 41. The suture anchor assembly as recited in claim 39 wherein the window has a proximal half, and at least a portion of the rigid support is located in the proximal half of the window. 